Abdominal Aortic Aneurysm In Women Research Articles

Risk Factors Associated With Increased Prevalence of Abdominal Aortic Aneurysm in Women

Risk Factors Associated With Increased Prevalence of Abdominal Aortic Aneurysm in Women

Meta-analysis of the current prevalence of screen-detected abdominal aortic aneurysm in women.

BackgroundAlthough women represent an increasing proportion of those presenting with abdominal aortic aneurysm (AAA) rupture, the current prevalence of AAA in women is unknown. The contemporary population prevalence of screen‐detected AAA in women was investigated by both age and smoking status.MethodsA systematic review was undertaken of studies screening for AAA, including over 1000 women, aged at least 60 years, done since the year 2000. Studies were identified by searching MEDLINE, Embase and CENTRAL databases until 13 January 2016. Study quality was assessed using the Newcastle–Ottawa scoring system.ResultsEight studies were identified, including only three based on population registers. The largest studies were based on self‐purchase of screening. Altogether 1 537 633 women were screened. Overall AAA prevalence rates were very heterogeneous, ranging from 0·37 to 1·53 per cent: pooled prevalence 0·74 (95 per cent c.i. 0·53 to 1·03) per cent. The pooled prevalence increased with both age (more than 1 per cent for women aged over 70 years) and smoking (more than 1 per cent for ever smokers and over 2 per cent in current smokers).ConclusionThe current population prevalence of screen‐detected AAA in older women is subject to wide demographic variation. However, in ever smokers and those over 70 years of age, the prevalence is over 1 per cent.

Risk factors associated with increased prevalence of abdominal aortic aneurysm in women.

Four randomized trials of men aged 65-80 years showed that aneurysm-related mortality was reduced by 40 per cent by ultrasound screening. Screening is considered economically viable when the prevalence of abdominal aortic aneurysm (AAA) is 1·0 per cent or higher. This is not the case for women, in whom the prevalence of AAA is less than 1 per cent. The aim of the present investigation was to determine the prevalence of AAA 3·0 cm or larger in women screened with ultrasound imaging, the risk factors associated with AAA in this population, and whether high-risk groups can be identified with an AAA prevalence of 1 per cent or greater. Demographic data and risk factors were collected from the first 50 000 women who attended for private cardiovascular screening in the UK. Tests included ultrasound screening for AAA, ankle : brachial pressure index (ABPI), carotid duplex imaging for carotid atherosclerosis, and electrocardiography for atrial fibrillation. AAA was detected in 82 of 50 000 women screened; these aneurysms were rare below the age of 66 years (7 of 24 499). In the 66-85-years age group there were 72 AAAs in 25 170 women (0·29 per cent). Univariable analysis demonstrated that a history of stroke/transient ischaemic attack (TIA), hypertension, smoking, atrial fibrillation, ABPI of less than 0·9 and internal carotid artery stenosis of at least 50 per cent were associated with an increased prevalence of AAA (P < 0·001). In multivariable linear logistic regression of risk factors, age 76 years or more, history of stroke/TIA, hypertension and smoking were independent predictors of AAA. This model had an area under the receiver operating characteristic (ROC) curve (AUC) of 0·711 (95 per cent c.i. 0·649 to 0·772) and could identify 2235 women who had 22 AAAs (prevalence 0·98 per cent). By adding ABPI, atrial fibrillation and carotid stenosis, the prediction improved to an AUC of 0·775 (0·724 to 0·826). This model could identify 3701 women who had 58 AAAs (prevalence 1·57 per cent). This report should stimulate consideration of a targeted AAA screening programme for women aged over 65 years.

Endovascular Abdominal Aneurysm Repair in Women: What are the Differences Between the Genders?

INTRODUCTION:Abdominal aortic aneurysm has a lower incidence in the female population, but a higher complication rate. It was been hypothesized that some anatomical differences of abdominal aortic aneurysm in women could be responsible for that. We proposed to analyze our data to understand the differences in the clinical and anatomical characteristics and the outcomes of patients undergoing endovascular aneurysm repair, according to gender.METHODS:A retrospective analysis of patients undergoing endovascular aneurysm repair between 2001-2013 was performed. Patients were divided according gender and evaluated regarding age, atherosclerotic risk factors, aneurysm anatomic features, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality. Two statistical studies were performed, first comparing women and men (Group A) and a second one comparing women and men, adjusted by age (Group B).RESULTS:Of the 171 patients, only 5.8% (n=10) were females. Women were older (P<0.05) and the number of women with no atherosclerotic risk factor was significantly higher. The comparison adjusted by age revealed women with statistically less smoking history, less cerebrovascular disease and ischemic heart disease. Women had a trend to more complex anatomy, with more iliac intern artery aneurysms, larger aneurysm diameter and neck angulations statistically more elevated. No other variables were statistically different between age groups, neither reintervention nor mortality rates.CONCLUSION:Our study showed a clear difference in the clinical characteristics of women. The female population was statistically older, and when compared with men adjusted by age, had less atherosclerotic risk factors and less target organ disease. Women showed a more complex anatomy but with the same outcomes.

Abstract 19470: Predicted Impact of Carotid Artery Atherosclerotic Disease for Screening of Abdominal Aortic Aneurysm in Women

Introduction: Screening of abdominal aortic aneurysm (AAA) for women has not been established. The aim of this study was to determine the predictive factors associated with ultrasonographic screening for AAA in patients who receive coronary angiogram (CAG) for suspicion of coronary artery disease (CAD). Methods: Study patients were consisted with 310 consecutive women over 65 years undergoing initial CAG. Both abdominal and carotid arterial ultrasonography were performed for all patients. Patients with known AAA were excluded in this study. AAA was defined as abdominal aortic diameter ≥30 mm by ultrasonographic examination. Carotid artery atherosclerotic disease (CAAD) was defined as a ≥50% stenosis of internal carotid artery (ICA) in NASCET criteria or ≥150cm/sec of ICA peak systolic velocity. Ankle branch pressure index (ABI) was also performed for all patients, and peripheral arterial disease (PAD) was defined as a ≤0.9 of ABI. CAD was defined as a ≥75% reduction in diameter in at least one major vessel in coronary angiography. Multivariate logistic regression analysis was used to study multiple risk factors (age, hypertension, diabetes, dyslipidemia, smoking, hemodialysis, cerebral infarction, CAD, CAAD and PAD) for AAA. Results: Of 310 patients, incidental AAA was detected in 10 patients (3.2%) and 1 had AAA diameter of ≥50mm. Patients with CAD included higher prevalence of AAA than those without (5.6% vs 0.7%, P=0.021). Multivariate analysis revealed that age (RR 1.3, 95% CI 1.1 to 1.5, p = 0.001) and CAAD (RR 8.5, 95% CI 1.3 to 55.7, p= 0.025) were significantly associated with a higher prevalence of AAA. Conclusions: Older age and presence of CAAD should be taken into account as a possible criterion for selective AAA ultrasonographic screening in women over 65 years for suspicion of CAD.

Attenuation of aortic aneurysms with stem cells from different genders

BackgroundNo medical therapies are yet available to slow abdominal aortic aneurysm (AAA) growth. This study sought to investigate the effect of different genders of bone marrow-derived mesenchymal stem cells (MSC) on AAA growth in a murine AAA model. Given the decreased rate of AAA in women, it is hypothesized that female MSC would attenuate AAA growth more so than male MSC. Materials and methodsAortas of 8–10-wk-old male C57Bl/6 mice were perfused with purified porcine pancreatic elastase to induce AAA formation. Bone marrow-derived MSC from male and female mice were dosed via tail vein injection (3 million cells per dose, 500 μL of volume per injection) on postaortic perfusion days 1, 3, and 5. Aortas were harvested after 14 d. ResultsMean aortic dilation in the elastase group was 121 ± 5.2% (mean ± standard error of the mean), while male MSC inhibited AAA growth (87.8 ± 6.9%, P = 0.008) compared with that of elastase. Female MSC showed the most marked attenuation of AAA growth (75.2 ± 8.3% P = 0.0004). Proinflammatory cytokines tumor necrosis factor α, interleukin 1β, and monocyte chemotactic protein-1 (MCP-1) were only decreased in tissues treated with female MSC (P = 0.017, P = 0.001, and P < 0.0001, respectively, when compared with elastase). ConclusionsThese data exhibit that female MSC more strongly attenuate AAA growth in the murine model. Furthermore, female MSC and male MSC inhibit proinflammatory cytokines at varying levels. The effects of MSC on aortic tissue offer a promising insight into biologic therapies for future medical treatment of AAAs in humans.

Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force recommendation statement.

Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for abdominal aortic aneurysm (AAA). The USPSTF commissioned a systematic review that assessed the evidence on the benefits and harms of screening for AAA and strategies for managing small (3.0 to 5.4 cm) screen-detected AAAs. These recommendations apply to asymptomatic adults aged 50 years or older. The USPSTF recommends 1-time screening for AAA with ultrasonography in men aged 65 to 75 years who have ever smoked. (B recommendation). The USPSTF recommends that clinicians selectively offer screening for AAA in men aged 65 to 75 years who have never smoked. (C recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for AAA in women aged 65 to 75 years who have ever smoked. (I statement). The USPSTF recommends against routine screening for AAA in women who have never smoked. (D recommendation).

Abdominal aortic aneurysms in women

Abdominal aortic aneurysms have an incidence that is approximately four to six times higher in men than in women. However, the incidence in women also rises with older age, although starting later in life than in men. There are also sex differences in the risk of rupture and in outcomes after endovascular and open abdominal aortic aneurysm repair. Various explanations have been proposed. Women historically have been under-represented in clinical trials to evaluate the differences between the sexes. We present a review of current recommendations and recent literature to help identify some of these differences.

Invited commentary

“Systematic review of guidelines on abdominal aortic aneurysm screening” is a well-written and timely article by Ferket and colleagues. After extensive literature review of guidelines on abdominal aortic aneurysm (AAA) screening, these authors found only seven guidelines that provided consensus recommendations for a one-time screening for (AAA): basically, men age 65 years and older should be screened using duplex ultrasound. However, as they correctly state, 90% of identified AAAs are small (3.0-3.9 cm). Policy makers, Centers for Medicare and Medicaid, and third-party payers need to pay attention to these data. Currently, Medicare allows for a one-time AAA screening in the “Welcome to Medicare” physical, an examination performed within the first 12 months of becoming a Medicare (part B) beneficiary. Unfortunately, this screening test is not always ordered or performed and not all beneficiaries meet the criteria to order the ultrasound, which include family history and smoking. Other groups, besides 65-year-old and older men, deserve research based recommendations for AAA screening. To date, there are no published screening guidelines for AAAs in women, persons with identified small AAAs, and younger men who may be at risk. There currently are not enough data for recommendations to firmly support screening these subgroups. Thus, they are left out of most guidelines, which then translates into very few persons being screened and minimal, if any, reimbursement for such testing without firm supportive evidence. For screening efforts to improve and potentially vulnerable populations to be identified prior to AAA rupture, policies and guidelines for primary care providers (PCPs) must be clarified. Delivery and implementation of guidelines must be precise for PCPs to make informed decisions in the care of their patients. As a practicing vascular surgeon, this article demonstrates the need for more research, particularly in the subgroups mentioned above, so that organized screening guidelines may be developed. With definitive screening guidelines, PCPs will be adequately informed and policy makers may take heed and alter reimbursement protocols We, as prominent stakeholders in the care of patients with AAAs, need to be in the forefront of the development of quality healthcare recommendations. It is encouraging to see that across continents, screening guidelines are similar. The opportunity exists for combined efforts to assess risk prediction models of rupture and operative risk. Furthermore, cost-benefit and outcomes analyses with large population-based studies will be possible with an across-continent joint research effort. Systematic review of guidelines on abdominal aortic aneurysm screeningJournal of Vascular SurgeryVol. 55Issue 5PreviewUsually, physicians base their practice on guidelines, but recommendations on the same topic may vary across guidelines. Given the uncertainties regarding abdominal aortic aneurysm (AAA) screening, physicians should be able to identify systematically and transparently developed recommendations. We performed a systematic review of AAA screening guidelines to assist physicians in their choice of recommendations. Full-Text PDF Open Archive

Epidemiology, Aetiology, Risk of Rupture and Treatment of Abdominal Aortic Aneurysms: Does Sex Matter?

To unravel the extent to which gender plays a role in the epidemiology, aetiology, risk of rupture and treatment of abdominal aortic aneurysms (AAAs) and to give an overview of these factors. A literature review was performed in the Medline database and Cochrane Library for gender-specific articles on epidemiology, aetiology, risk of rupture and treatment of AAAs. Our literature review suggests that the prevalence of AAA in women is underestimated. Regarding aetiology, an oestrogen-mediated reduction in macrophage MMP-9 production seems to be an important mechanism causing gender-related differences in AAA development. We found consensus in the literature that women run a greater risk of rupture compared to men under the current management rules for AAAs. Their treatment mortality also seems to be higher for both elective and ruptured repair. Gender-specific guidelines should be put into place for the management of AAAs and awareness for this disease should be increased, both in women themselves and in their doctors.

Abdominal Aortic Aneurysm Events in the Women's Health Initiative: Cohort Study

Conclusion: There is a strong positive association with age and smoking and abdominal aortic aneurysm (AAA) in women. There is a negative association with diabetes. Summary: Aortic aneurysms are more common in men but may be more deadly in women. The Women's Health Initiative (WHI) involved clinical investigation of strategies of prevention of common diseases in 161,808 women. The authors used these data to assess for associations between potential risk factors for AAA and subsequently clinically important AAA events, rupture, and repair in postmenopausal women. This was a cohort analysis of data from the WHI. Mean follow-up was 7.8 years. The WHI enrolled women who were postmenopausal and aged 50 to 79 years. The main outcome measure was the association of self-reported or measured baseline variables with AAA repair or rupture. AAA events occurred in 184 women. Events were strongly associated with age and smoking. Ever smoked, current smoking, and amount smoked all contributed independent risks. Additional positive associations were seen for height, cholesterol-lowering treatment, hypertension, and coronary and peripheral arterial disease. There was a negative association with diabetes (odd ratio, 0.29; 95% confidence interval, 0.13-0.68) and with postmenopausal hormone therapy. Comment: Although the incidence of AAA is significantly lower in women than in men, most risk factors for AAA and negative associations appear to be the same for men and women. The authors also found a negative association between AAA in women and postmenopausal hormone therapy, which suggests that estrogen may have a favorable effect in reducing the development of AAA in women. However, other studies found increased aneurysmal disease in patients treated with hormone therapy. It therefore remains unclear why the prevalence of AAA differs so much by sex. One may postulate a thus far unknown gender-associated biologic explanation. There may also be unknown confounders of lifestyle in the WHI data. It does appear, however, that the negative association between AAA and diabetes is solid for both men and women.

Risk Factors for Abdominal Aortic Aneurysm Events in Women

Most studies of abdominal aortic aneurysm (AAA) have focused on men; thus, little is known about risk factors for AAA in women. In a prospective

Abdominal aortic aneurysm in women: Prevalence, risk factors, and implications for screening

Abdominal aortic aneurysm in women: Prevalence, risk factors, and implications for screening

Abdominal aortic aneurysm in women: Prevalence, risk factors, and implications for screening

Accurate data regarding the prevalence and associated risk factors for aneurysmal disease is essential when determining the appropriateness of screening for abdominal aortic aneurysms (AAA). Although women are poorly represented in most large studies of AAA prevalence, the US Preventative Services Task Force recently recommended against primary screening for AAA in women. The purpose of this analysis was to define the prevalence and risk factors associated with the development of AAA in women. A free duplex ultrasound screening was offered to men and women with cardiovascular risk factors or a family history of AAA. Patients were recruited through advertising at local screening centers and screenings were performed between 2004 and 2006. Demographic information and cardiovascular and aneurysmal disease risk factors were obtained for each patient through a questionnaire. A total of 17,540 subjects were screened for AAA, including 10,012 women (mean age 69.6 years) and 7528 men (mean age 70.0 years). Univariate and multivariable logistic regression analysis was performed on the subset of women that were screened to determine risk factors for and prevalence of AAA. Seventy-four aneurysms were detected in women (including four aneurysms >5 cm diameter and 70 aneurysms 3 to 5 cm diameter) while 291 were detected in men, resulting in prevalence rates of 0.7% and 3.9%, respectively. Increasing age (odds ratio [OR]= 4.57, 95% confidence interval [CI] 1.98 to 10.54, P < .0001), history of tobacco use (OR = 3.29, 95% CI 1.86 to 5.80, P < .0001), and cardiovascular disease (OR= 3.57, 95% CI 2.19 to 5.84, P < .0001) were independently associated with AAA in women on univariate and multivariable analysis. Women with multiple atherosclerotic risk factors were more commonly found to have AAAs and had a prevalence rate of AAA as high as 6.4%. Although the medical literature suggests a low prevalence rate of AAA in women in the general population, specific risk factors are associated with the development of AAA, and subgroups of women can be identified that are at a substantially increased risk of aneurysmal disease. In particular, elevated rates of AAA were found among women of advanced age (> or =65 years) with a history of smoking or heart disease. These data support the notion that women with such risk factors should be considered for AAA screening.

Abdominal Aortic Aneurysm

Most manifestations of cardiovascular disease are more common in men than in women. However, cardiovascular disease is the most common cause of death in women worldwide.1 Coronary heart disease in women has a worse outcome than in men, and this has attracted considerable attention in recent years, with calls for more gender-specific research.1,2 Abdominal aortic aneurysms (AAAs) also are less common in women than in men, and, as with coronary heart disease, there is evidence that women with AAA also have a worse prognosis. The present review addresses the epidemiology, development, natural history, management, and outcomes of AAA in women. When the definition of a maximum external diameter ≥3 cm is used, the prevalence of AAA is up to 6 times greater in men than in women.3,4 In a community-based screening study of the older population, the prevalence of AAA was 1.3% in women compared with 7.6% in men.4 Similarly, the ratio of men to women in surgical series is ≈5:1.5–7 Because of the relatively low prevalence, women were excluded from the large trials of screening for AAA.8–10 The prevalence in women from families with a strong history of AAA may be as high as 8.3%, and these women should be offered screening.11 Modeling studies have indicated that screening for AAA in women could be cost-effective because the rupture rate appears to be much higher in women than in men.12 The incidence of AAA has continued to rise over the last 4 decades.13–16 Initially, a similar pattern was seen in both genders, although the increase in mortality and admission rate has been become more marked in women.15,16 Inspection of data derived from national (England and Wales) statistics shows that the annual number of hospital admissions for aneurysm rupture between 1997 …

Influence of sex on expansion rate of abdominal aortic aneurysms

Conclusion: Abdominal aortic aneurysms (AAA) grow at a significantly higher rate in women than men. Summary: Longitudinal studies have indicated that aneurysms that rupture have higher expansion rates than nonrupture aneurysms (J Vasc Surg 2003;37:280-4 and N Engl J Med 2002;346:1437-44). Larger aneurysms grow at a higher rate than smaller aneurysms, and a recent screening program suggested female sex is also a risk factor for more rapid growth of an AAA (Eur J Vasc Endo Surg 2005;29:145-9). In this study, the authors assess the effect of sex on growth rate of AAA. The authors studied patients identified between January 1985 and August 2005. Some had AAA but were not considered for early repair. These patients were followed up with serial abdominal ultrasound examinations with measurements of maximum transverse and anteroposterior dimensions. A total of 1255 patients (824 men and 431 women) were followed up for a median of 30 months (range, 6 to 185 months), with a median of six examinations per patient (range, 2 to 37). The median initial diameter was 41 mm (range, 25 to 83 mm). Median growth rate was 2.79 mm/y (range, –4.80 to 37.02 mm/y). Growth rate of AAAs in women was greater than that in men: 3.67 mm/y (range. –1.2 to 37.02 mm/y) in women vs a median growth rate in men of 2.03 mm/y (range -4.80 to 21.00 mm/y; P < .01). By weighted linear regression analysis, the initial anteroposterior AAA diameter (P < .001) and female sex (P = .006) were predictors of increased AAA growth rate. Conclusion: This is another bit of evidence suggesting that AAA disease may be more virulent in women than men. Previous studies have suggested rupture at smaller diameters in women than men, and now it appears that female sex may be an independent risk factor for increased expansion rate of an AAA. This type of emerging information has significant implications for the timing of AAA repair in women and frequency of nonoperative follow-up.

Influence of sex on expansion rate of abdominal aortic aneurysms

The UK Small Aneurysm Trial suggested that female sex is an independent risk factor for rupture of abdominal aortic aneurysm (AAA). This study assessed the effect of sex on the growth rate of AAA. Between January 1985 and August 2005 all patients who were referred to the Royal Infirmary of Edinburgh with an AAA who were not considered for early aneurysm repair were assessed by serial abdominal ultrasonography. Maximum anteroposterior and transverse diameters of the AAAs were measured. A total of 1255 patients (824 men and 431 women) were followed up for a median of 30 (range 6-185) months. A median of six examinations (range 2-37) was performed for each patient. Median diameter on initial examination was 41 (range 25-83) mm. Median growth rate overall was 2.79 (range - 4.80-37.02) mm per year. Median growth rate of AAA was significantly greater in women than men (3.67 (range - 1.2-37.02) versus 2.03 (range - 4.80-21.00) mm per year; P < 0.01). Weighted linear regression analysis revealed that large initial anteroposterior AAA diameter and female sex were significant predictors of faster aneurysm growth rate (P < 0.001 and P = 0.006 respectively). The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.

Increased Growth Rate of Abdominal Aortic Aneurysms in Women. The Tromsø Study

Increased Growth Rate of Abdominal Aortic Aneurysms in Women. The Tromsø Study

Abdominal aortic aneurysms in women

Abdominal aortic aneurysms in women

Increased Growth Rate of Abdominal Aortic Aneurysms in Women. The Tromsø Study

Objectives The present study was undertaken in order to assess the effect of gender on the growth rate of abdominal aortic aneurysms (AAAs). Methods One hundred and eighty-five men and 49 women with AAAs were studied, mean follow-up 62 months, giving 14,544 patient-months of follow-up. A mean of 16 ultrasound examinations was performed on each patient. Results The mean growth rate was 1.82; 1.65 and 2.43 mm per year in men and women, respectively. In a weighted linear regression analysis, high initial diameter and female gender were independent and significant ( p<0.001 and p=0.003, respectively) predictors for increased growth rate of AAAs. None of the other considered risk factors predicted the growth rate. Conclusions This is the first study to report a significantly different growth rate of AAAs in females compared to males. It, thus, adds evidence to the view that AAA is a more malignant condition in females than in males and could have implications for the frequency of follow-up in women.